Abstract
Background: First aid training in secondary education enhances emergency preparedness and supports public health. Despite its inclusion in many school curricula, there is no consensus on the most effective teaching methodologies. This systematic review aims to compare instructional strategies used in first aid training during Physical Education and evaluate their impact on students' knowledge, practical skills, and confidence. Methods: A systematic review was conducted in accordance with PRISMA 2020 guidelines. Six databases (SCOPUS, Web of Science, ERIC, DIALNET, MEDLINE, and PsycINFO) were searched up to December 2024. Eligible studies were quasi-experimental or observational, involved students aged 11-18, and focused on first aid instruction within Physical Education. Methodological quality was assessed using the PEDro scale. Results: Eleven studies with a total of 3069 students aged 11-18 were included. Active and technology-based methodologies outperformed traditional approaches, improving knowledge acquisition (10.2-30.5%) and practical skill development (18.6-42.3%). Long-term retention ranged from 14.2% to 45.8%, with longer interventions yielding better outcomes. Gamification, simulations, and peer learning improved CPR quality and boosted student confidence. However, most studies assessed only short-term outcomes, limiting conclusions about sustained learning. Conclusions: Active methodologies, particularly gamification, simulation, and cooperative learning, enhance knowledge retention, practical skills, and confidence in providing first aid. Although the results were consistently positive, methodological heterogeneity and limited long-term follow-up reduce their generalizability. Further high-quality, longitudinal research is needed to identify the most effective and sustainable strategies. These findings support integrating first aid training into Physical Education as a public health initiative to strengthen emergency preparedness in schools.